Promoting a culture of safety as a patient safety strategy: a systematic review

Perceptions of hospital electronic health record (EHR) training, support, and patient safety by staff position and tenure

BACKGROUND

Hospitals rely on their electronic health record (EHR) systems to assist with the provision of safe, high quality, and efficient health care. However, EHR systems have been found to disrupt clinical workflows and may lead to unintended consequences associated with patient safety and health care professionals' perceptions of and burden with EHR usability and interoperability. This study sought to explore the differences in staff perceptions of the usability and safety of their hospital EHR system by staff position and tenure.

METHODS

We used data from the AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey Version 1.0 Database and the SOPS Health Information Technology Patient Safety Supplemental Items ("Health IT item set") collected from 44 hospitals and 8,880 staff in 2017. We used regression modeling to examine perceptions of EHR system training, EHR support & communication, EHR-related workflow, satisfaction with the EHR system, and the frequency of EHR-related patient safety and quality issues by staff position and tenure, while controlling for hospital ownership type and bed-size.

RESULTS

In comparison to RNs, pharmacists had significantly lower (unfavorable) scores for EHR system training (regression coefficient = -0.07; p = 0.047), and physicians, hospital management, and the IT staff were significantly more likely to report high frequency of inaccurate EHR information (ORs = 2.03, 1.34, 1.72, respectively). Compared to staff with 11 or more years of hospital tenure, new staff (less than 1 year at the hospital) had significantly lower scores for EHR system training, but higher scores for EHR support & communication (p < 0.0001). Dissatisfaction of the EHR system was highest among physicians and among staff with 11 or more years tenure at the hospital.

CONCLUSIONS

There were significant differences in the Health IT item set's results across staff positions and hospital tenure. Hospitals can implement the SOPS Health IT Patient Safety Supplemental Items as a valuable tool for identifying incongruity in the perceptions of EHR usability and satisfaction across staff groups to inform targeted investment in EHR system training and support.

Quality improvement in neonatal care through enhanced patient safety and clinical risk management: a before-and-after study about neonatal sepsis

Introduction

Neonatal sepsis, classified into early-onset and late-onset based on symptom timing, poses significant risks of morbidity and mortality, especially in low birth weight infants. Effective clinical risk management protocols are crucial in reducing these risks.

Methods

This before-and-after study evaluated the impact of a newly implemented clinical risk management protocol in the Neonatology and Neonatal Intensive Care Unit (NICU) at Policlinico Hospital-University of Bari. The study included 399 neonates over three years, comparing pre- and post-protocol outcomes. Data collection focused on maternal and neonatal demographics, infection rates, and hospital stay lengths. Statistical analysis included t-tests, Wilcoxon-Mann-Whitney tests, and logistic regression models.

Results

The study found no significant differences in neonatal pathologies or demographics between pre- and post-protocol groups. However, post-protocol implementation showed a notable reduction in umbilical venous catheter (UVC) infections (p = 0.018) and improved hospital stay lengths. Blood and urine cultures did not show significant changes in microbial patterns post-protocol.

Discussion

The findings underscore the effectiveness of structured clinical risk management protocols in enhancing neonatal outcomes, particularly in reducing specific infection risks. Despite the study's limitations, including its observational nature and sample size, the results advocate for broader adoption and further research on these protocols in diverse healthcare settings. The positive outcomes highlight the importance of continuous clinical risk management efforts in high-risk neonatal environments.

Relationship between patient safety culture and patient experience in hospital settings: a scoping review

BACKGROUND

Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings.

METHODS

This study was performed using the five stages of Arksey and O'Malley's Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria.

RESULTS

4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients' and families' perspectives.

CONCLUSION

The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

BACKGROUND

Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists.

METHODS

This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system.

RESULTS

Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%).

CONCLUSIONS

These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture

Background

Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities.

Methods

A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics.

Results

Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges.

Conclusion

The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.

Eastern Association for the Surgery of Trauma system wellness white paper: An evaluation of wellness from a systems perspective

ABSTRACT

Providers are charged with responsibility to maintain their own health and wellness; however, well-being is multifactorial and the construct lacks clarity. In the current state of health care, burnout is on the rise with increasing demands for clinical productivity and strained system resources. The health care industry has recognized wellness's patient safety and financial impact, recently applying research and resources to identify sustainable solutions. We reviewed the wellness literature with a focus on systems to provide a framework for consensus building for a quality acute care surgery system. Our review revealed several areas within system wellness for consideration: (1) provider wellness, (2) culture of safety, (3) learning health systems, and (4) organizational perspectives. We provide specific system recommendations for the acute care surgery practice to preserve our workforce by creating a system that works for its providers.

Adverse event reporting attitude and its individual and organizational predictors among nursing staff: A multisite study in Chinese nursing homes

This study explored the status of adverse event reporting attitudes and its predictors among nursing staff in Chinese nursing homes. A cross-sectional study was conducted with 475 nursing staff, and they completed sociodemographic and facility-related questionnaire, Incident Reporting Attitude Scale, Adverse Event Reporting Awareness Scale, and Nursing Home Survey on Patient Safety Culture. Univariate analysis and multiple linear regression models were performed. The mean score for adverse event reporting attitude was 125.87 (SD=15.35). The predictors included individual variables, such as education level (β=0.129, p = 0.001) and working years (β=-0.102, p = 0.007), and organizational variables, such as patient safety culture (β=0.503, p < 0.001) and adverse event reporting awareness (β=0.261, p < 0.001). These factors explained 35.3 % of total variance. Managers in nursing homes should strengthen team-targeted education and training for nursing staff with longer working years and lower educational backgrounds. Meanwhile, a simplified and non-punitive reporting system should be established to create positive safety management climate.

Quality and Safety in Nursing: Recommendations From a Systematic Review

ABSTRACT

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

Understanding Team Dynamics and Culture of Safety Using Video Reflexive Ethnography during Real-Time Emergent Intubation

Rationale: Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives: To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods: Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results: Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions: The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.

Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation

Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.

Patient safety culture in private hospitals in China: a cross-sectional study using the revised Hospital Survey on Patient Safety Culture

Background

This study aimed to translate the revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0) to Mandarin, evaluate its psychometric properties, and apply it to a group of private hospitals in China to identify the determinants associated with patient safety culture.

Methods

A two-phase study was conducted to translate and evaluate the HSOPSC 2.0. A cross-cultural adaptation of the HSOPSC 2.0 was performed in Mandarin and applied in a cross-sectional study in China. This study was conducted among 3,062 respondents from nine private hospitals and 11 clinics across six cities in China. The HSOPSC 2.0 was used to assess patient safety culture. Primary outcomes were measured by the overall patient safety grade and patient safety events reported.

Results

Confirmatory factor analysis results and internal consistency reliability were acceptable for the translated HOSPSC 2.0. The dimension with the highest positive response was "Organizational learning - Continuous improvement" (89%), and the lowest was "Reporting patient safety event" (51%). Nurses and long working time in the hospital were associated with lower assessments of overall patient safety grades. Respondents who had direct contact with patients, had long working times in the hospital, and had long working hours per week reported more patient safety events. A higher level of patient safety culture implies an increased probability of a high overall patient safety grade and the number of patient safety events reported.

Conclusion

The Chinese version of HSOPSC 2.0 is a reliable instrument for measuring patient safety culture in private hospitals in China. Organizational culture is the foundation of patient safety and can promote the development of a positive safety culture in private hospitals in China.

Healthcare professionals' perceptions of patient safety in European emergency departments: a comparative analysis of survey results

Patient safety is a significant concern worldwide. The Emergency Departments (EDs) are vulnerable to adverse events. Europe, with its diverse healthcare systems, differs in patient safety. This study aimed to identify safety challenges through a comparative analysis of healthcare professionals' perceptions of patient safety in European EDs. In early 2023, a validated questionnaire was distributed to European ED professionals, meeting specific response rate criteria. The questionnaire included five safety domains and additional questions about infection control and team morale, with 36 ordinal scale questions. Responses ranged in five levels from "Never" to "Always," and the scores were summed to calculate the total safety score (TSS). The study examined the impact of per capita healthcare expenditure on safety perceptions using descriptive statistics, correlation assessments and SPSS 17 used for the analysis. The analysis of 1048 valid responses from 24 European countries revealed significant variability in safety perceptions. Teamwork scored highest, signifying effective collaboration. Common safety issues included overcrowding, patient flow management, understaffing, limited training and facilities for mental illnesses. TSS showed correlation with team morale and infection control, but no correlation with per capita healthcare expenditure. This comparative study underlines the disparities in patient safety perceptions across European EDs. Each country displayed unique safety concerns. Safety perceptions did not align with per capita healthcare expenditure, indicating that addressing ED safety needs multifaceted strategies. Policymakers can leverage these findings to inform strategic planning, encouraging targeted interventions to enhance patient safety at both the national and European levels.

Enhancing patient safety: detection of in-hospital hazards and effect of training on detection (by training in a low-fidelity simulation Room of Improvement based on hospital-specific CIRS cases)

IMPORTANCE

Adequate situational awareness in patient care increases patient safety and quality of care. To improve situational awareness, an innovative, low-fidelity simulation method referred to as Room of Improvement, has proven effective in various clinical settings.

OBJECTIVE

To investigate the impact after 3 months of Room of Improvement training on the ability to detect patient safety hazards during an intensive care unit shift handover, based on critical incident reporting system (CIRS) cases reported in the same hospital.

METHODS

In this educational intervention, 130 healthcare professionals observed safety hazards in a Room of Improvement in a 2 (time 1 vs time 2)×2 (alone vs in a team) factorial design. The hazards were divided into immediately critical and non-critical.

RESULTS

The results of 130 participants were included in the analysis. At time 1, no statistically significant differences were found between individuals and teams, either overall or for non-critical errors. At time 2, there was an increase in the detection rate of all implemented errors for teams compared with time 1, but not for individuals. The detection rate for critical errors was higher than for non-critical errors at both time points, with individual and group results at time 2 not significantly different from those at time 1. An increase in the perception of safety culture was found in the pre-post test for the questions whether the handling of errors is open and professional and whether errors are discussed in the team.

DISCUSSION

Our results indicate a sustained learning effect after 12 weeks, with collaboration in teams leading to a significantly better outcome. The training improved the actual error detection rates, and participants reported improved handling and discussion of errors in their daily work. This indicates a subjectively improved safety culture among healthcare workers as a result of the situational awareness training in the Room of Improvement. As this method promotes a culture of safety, it is a promising tool for a well-functioning CIRS that closes the loop.

Lessons learnt on patient safety in dentistry through a 5-year nationwide database study on iatrogenic harm

Safe delivery of care is a priority in dentistry, while basic epidemiological knowledge of patient safety incidents is still lacking. The objectives of this study were to (1) classify patient safety incidents related to primary dental care in Denmark in the period 2016-2020 and study the distribution of different types of dental treatment categories where harm occurred, (2) clarify treatment categories leading to "nerve injury" and "tooth loss" and (3) assess the financial cost of patient-harm claims. Data from the Danish Dental Compensation Act (DDCA) database was retrieved from all filed cases from 1st January 2016 until 31st December 2020 pertaining to: (1) The reason why the patient applied for treatment-related harm compensation, (2) the event that led to the alleged harm (treatment category), (3) the type of patient-harm, and (4) the financial cost of all harm compensations. A total of 9069 claims were retrieved, of which 5079 (56%) were found eligible for compensation. The three most frequent categories leading to compensation were "Root canal treatment and post preparation"(n = 2461, 48% of all approved claims), "lack of timely diagnosis and initiation of treatment" (n = 905, 18%) and "surgery" (n = 878, 17%). Damage to the root of the tooth accounted for more than half of all approved claims (54.36%), which was most frequently a result of either parietal perforation during endodontic treatment (18.54%) or instrument fracture (18.89%). Nerve injury accounted for 16.81% of the approved claims. Total cost of all compensation payments was €16,309,310, 41.1% of which was related to surgery (€6,707,430) and 20.4% (€3,322,927) to endodontic treatment. This comprehensive analysis documents that harm permeates all aspects of dentistry, especially in endodontics and surgery. Neglect or diagnostic delays contribute to 18% of claims, indicating that harm does not solely result from direct treatment. Treatment harm inflicts considerable societal costs.

Psychometric properties and criterion related validity of the Norwegian version of hospital survey on patient safety culture 2.0

BACKGROUND

Several studies have been conducted with the 1.0 version of the Hospital Survey on Patient Safety Culture (HSOPSC) in Norway and globally. The 2.0 version has not been translated and tested in Norwegian hospital settings. This study aims to 1) assess the psychometrics of the Norwegian version (N-HSOPSC 2.0), and 2) assess the criterion validity of the N-HSOPSC 2.0, adding two more outcomes, namely 'pleasure of work' and 'turnover intention'.

METHODS

The HSOPSC 2.0 was translated using a sequential translation process. A convenience sample was used, inviting hospital staff from two hospitals (N = 1002) to participate in a cross-sectional questionnaire study. Data were analyzed using Mplus. The construct validity was tested with confirmatory factor analysis (CFA). Convergent validity was tested using Average Variance Explained (AVE), and internal consistency was tested with composite reliability (CR) and Cronbach's alpha. Criterion related validity was tested with multiple linear regression.

RESULTS

The overall statistical results using the N-HSOPSC 2.0 indicate that the model fit based on CFA was acceptable. Five of the N-HSOPSC 2.0 dimensions had AVE scores below the 0.5 criterium. The CR criterium was meet on all dimensions except Teamwork (0.61). However, Teamwork was one of the most important and significant predictors of the outcomes. Regression models explained most variance related to patient safety rating (adjusted R2 = 0.38), followed by 'turnover intention' (adjusted R2 = 0.22), 'pleasure at work' (adjusted R2 = 0.14), and lastly, 'number of reported events' (adjusted R2=0.06).

CONCLUSION

The N-HSOPSC 2.0 had acceptable construct validity and internal consistency when translated to Norwegian and tested among Norwegian staff in two hospitals. Hence, the instrument is appropriate for use in Norwegian hospital settings. The ten dimensions predicted most variance related to 'overall patient safety', and less related to 'number of reported events'. In addition, the safety culture dimensions predicted 'pleasure at work' and 'turnover intention', which is not part of the original instrument.

Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature

BACKGROUND

In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified?

METHODS AND ANALYSIS

We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects.

RESULTS

We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units.

DISCUSSION

This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Lebanese medical students' attitudes towards patient safety and medical error disclosure: A cross-sectional study

OBJECTIVE

To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure.

METHODS

This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected.

RESULTS

Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of 'Team functioning' followed by 'Working hours as an error cause'. More positive attitudes were perceived among male students in the domains of 'Professional incompetence as an error cause' and 'Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of 'Working hour as an error cause'. Older medical students had more positive attitudes in the domain of 'Team functioning' than younger students.

CONCLUSION

Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon.

The Impact of Patient Education on Inpatient Fall Risk: A Review

» Patient falls in the hospital are one of the leading sentinel events identified by the Joint Commission.» Hospital falls affect orthopaedic patients of older age at higher rates, and up to 34% of falls lead to injury such as fractures.» Patients often misperceive their fall risk, and modalities aimed at educating patients to address the incongruence between perceived and actual fall risk significantly reduce fall rate and injurious fall rate.» Adequate communication with patients and their families with the goal of educating them may diminish the physical, psychological, and emotional detriment to orthopaedic patients.

Patient safety climate research in primary care dentistry: A systematic scoping review

BACKGROUND

Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited.

OBJECTIVE

To systematically explore the evidence regarding assessing patient safety climate in dentistry.

METHODS

We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected.

RESULTS

Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75.

DISCUSSION

Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

Ratios d’incidents et d’accidents totaux et médicamenteux par 1000 jours-présence en établissement de santé au Québec: une étude exploratoire

Background

Since 2022, it has been mandatory in Québec to report all incidents and accidents (I&As) occurring in health-care facilities. Since 2011, a summary report of these I&As has been published each year. However, it is difficult to compare health facilities given that no denominator is specified and ratios are not calculated.

Objective

The primary objective was to calculate the ratios of total I&As and medication-related I&As per 1000 inpatient-days per type of facility for all health-care facilities in Québec.

Methods

This retrospective descriptive study was based on data from the period of April 1, 2016, to March 31, 2021. Data were extracted from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec (Registre national des incidents et accidents survenus lors de la prestation des soins et services de santé au Québec) and financial reports. The ratios of total I&As/1000 inpatient-days and medication-related I&As/1000 inpatient-days, expressed as the mean ± standard deviation and median [minimum; maximum], were calculated.

Results

A total of 85 health-care facilities had usable data, specifically 33 acute-care facilities, 45 long-term care facilities, and 7 rehabilitation facilities. The mean ratio for total I&As/1000 inpatient-days varied from 33 ± 19 to 38 ± 22 in acute-care facilities, from 14 ± 5 to 16 ± 7 in long-term care facilities, and from 99 ± 39 to 147 ± 55 in rehabilitation facilities. The mean ratio for medication-related I&As/1000 inpatient-days varied from 11 ± 7 to 12 ± 7 in acute care facilities, from 3 ± 2 to 4 ± 3 in long-term care facilities, and from 24 ± 10 to 40 ± 21 in rehabilitation facilities.

Conclusions

This exploratory study demonstrated the feasibility of calculating I&A ratios from the National Register of Incidents and Accidents Occurring during the Provision of Health Care and Social Services in Québec. These ratios facilitate discussion of the reporting culture of I&As within the health-care system. It is hoped that these ratios will be added to future annual reports from the Québec I&A register.

Human Healthcare and Its Pharmacy Component from a Safety Point of View

Healthcare plays a crucial role in public and national safety as a significant part of state activity and a component of national safety, whose mission is to organize and ensure affordable medical care for the population. The four stages of the genesis of healthcare safety development with the corresponding safety models of formation were defined: technical, human factor or security management, systemic security management, and cognitive complexity. It was established that at all stages, little attention is paid to the issues of the formation of the pharmaceutical sector's safety. Taking into account the development of safety models that arise during the four stages of the genesis of safety science, we have proposed a model of the evolution of pharmaceutical safety formation. At the same time, future research is proposed to focus on new holistic concepts of safety, such as "Safety II", evaluation and validation methods, especially in the pharmaceutical sector, where the development of this topic remained in the second stage of the evolution of science, the search for pharmaceutical errors related to drugs.

Assessment of Patient Safety Culture Among Nurses Working at Tertiary Care Hospitals in Aljouf Region, Saudi Arabia

INTRODUCTION

Patient safety is a fundamental element in healthcare quality and a major challenge in achieving universal health coverage, especially in low- and middle-income countries. The first step to improve patient safety is to evaluate the safety culture in hospitals. This study aimed to investigate the patient safety culture among nurses and determine the factors affecting it.

METHODS

This cross-sectional study was conducted among 423 nurses working at tertiary care hospitals in the Al-Jouf region in Saudi Arabia.

RESULTS

The highest score for patient safety among nurses was for teamwork within units (16.41 ± 2.44). The lowest score was for nonpunitive response to errors (5.87 ± 1.92). In addition, 83% of the participants did not report any events in the past 12 months. More perception of patient safety was significantly higher among females than males in dimensions of teamwork within units, frequency of events reported, and staffing. Furthermore, teamwork within units, management support for patient safety, staffing, non-punitive response to errors, and handoffs and transitions were significantly higher among participants in direct contact with patients. The Hospital Survey on Patient Safety Culture (HSOPSC) scale is significantly higher among non-Saudi nurses, nurses with bachelor's education, nurses with less working hours per week, and those who had training on patient safety.

CONCLUSION

The current study showed that the majority of the participants did not report any events in the past 12 months. The highest score for patient safety culture dimensions among nurses was for teamwork within units while the lowest score was for nonpunitive response to errors.

An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study

BACKGROUND

Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate.

PURPOSE

The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate.

DESIGN

A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines.

METHODS

The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis.

RESULTS

Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate.

CONCLUSION

The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety.

IMPLICATIONS

Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management.

PATIENT OR PUBLIC CONTRIBUTION

The study included nurses in the intervention and the data collection processes.

IMPACT

Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.

Implementation of a comprehensive clinical risk management system in a university hospital

BACKGROUND

Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms.

METHODS

The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement.

RESULTS

Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) .

CONCLUSION

The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.

A realist synthesis of interprofessional patient safety activities and healthcare student attitudes towards patient safety

Interprofessional education (IPE) has been used for instilling a positive safety culture within healthcare, yet what interventions work to change healthcare student attitudes and how improved patient safety outcomes are best achieved with this intervention, is unclear and challenging to evaluate. A realist synthesis was undertaken to ascertain how, why, and in what circumstances IPE activities result in a positive change to student attitudes to patient safety. Database searches of CINAHL, MEDLINE, Scopus, and Eric were undertaken in April 2022 to identify relevant studies. Synthesis with a realist framework of analysis, coupled with the development of a program theory was conducted to identify interactions among contexts, intervention, mechanisms, and outcomes (CIMO). Twenty-three articles eligible for inclusion articulated environments in which varied contexts, interventions, and mechanisms were activated to influence student attitudes to patient safety. Findings from this realist synthesis informs awareness into the methods of delivering and evaluating IPE activities and offers new perspectives for educators in planning and evaluating future IPE from a collaborative and positive safety culture perspective.

Efficacy and Impact of a Multimodal Intervention on CT Pulmonary Angiography Ordering Behavior in the Emergency Department

OBJECTIVE

To evaluate the efficacy of a multimodal intervention in reducing CT pulmonary angiography (CTPA) overutilization in the evaluation of suspected pulmonary embolism in the emergency department (ED).

METHODS

Previous mixed-methods analysis of barriers to guideline-concordant CTPA ordering results was used to develop a provider-focused behavioral intervention consisting of a clinical decision support tool and an audit and feedback system at a multisite, tertiary academic network. The primary outcome (guideline concordance) and secondary outcomes (yield and CTPA and D-dimer order rates) were compared using a pre- and postintervention design. ED encounters for adult patients from July 5, 2017, to January 3, 2019, were included. Fisher's exact tests and statistical process control charts were used to compare the pre- and postintervention groups for each outcome.

RESULTS

Of the 201,912 ED patient visits evaluated, 3,587 included CTPA. Guideline concordance increased significantly after the intervention, from 66.9% to 77.5% (P < .001). CTPA order rate and D-dimer order rate also increased significantly, from 17.1 to 18.4 per 1,000 patients (P = .035) and 30.6 to 37.3 per 1,000 patients (P < .001), respectively. Percent yield showed no significant change (12.3% pre- versus 10.8% postintervention; P = .173). Statistical process control analysis showed sustained special-cause variation in the postintervention period for guideline concordance and D-dimer order rates, temporary special-cause variation for CTPA order rates, and no special-cause variation for percent yield.

CONCLUSION

Our success in increasing guideline concordance demonstrates the efficacy of a mixed-methods, human-centered approach to behavior change. Given that neither of the secondary outcomes improved, our results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies and D-dimer ordering.

Developing patient safety scale for hospitals

Background/aim

The study aimed to contribute to the literature with a reliable and valid scale for hospitals to be used in determining the current patient safety culture and following up on its development.

Materials and methods

The study was conducted with the participation of 1137 healthcare professionals selected using the convenience sampling method in 3 secondary-care state hospitals and three research and training hospitals, one of which was affiliated with a medical faculty, and two were affiliated with the Health Sciences University. To begin with, to discover the latent structure of the items on the scale, an Exploratory Factor Analysis (EFA) was performed. Additionally, to determine the factor structure of the scale, the Confirmatory Factor Analysis (CFA) method was used. The Cronbach's alpha coefficient was calculated to check the reliability of the responses.

Results

According to Kaiser-Meyer-Olkin (KMO = 0.924) coefficient and the result of Bartlett's test of sphericity (χ 2 = 9748.777, df = 770), it was determined that the data structure was suitable for factor analysis. The Cronbach's alpha coefficient of the total scale was found to be 0.921. According to the EFA results, the scale was determined to have seven subscales, which were 1. Organizational Learning, Development, and Communication, 2. Management Support and Leadership, 3. Reporting Patient Safety Events, 4. Number of Personnel and Working Hours, 5. Response to Error, 6. Teamwork, and 7. Working Environment. The goodness-of-fit index results of the scale showed a good model fit (χ 2 / df = 3.04, RMSEA = 0.06, CFI = 0.97, NFI = 0.95, IFI = 0.97, SRMR = 0.06). The Cronbach's alpha coefficients of the subscales varied between 0.66 and 0.91.

Conclusion

The results showed that the Patient Safety Scale for Hospitals is a valid and reliable measurement instrument for healthcare professionals.

Credentialing of stereotactic radiosurgery and stereotactic body radiation therapy programs for quality and safety: The Novalis Certified Program

The expectation of quality and safety is a fundamental tenet in all areas of healthcare, and a cornerstone of best practice is a process of continuous learning and continuous improvement. Independent audits and peer review of radiotherapy programs are an important mechanism for identifying process or technology gaps, for highlighting areas for improvement, and for incorporating within continuous improvement processes. In the field of radiotherapy, independent certification programs exist within various national and/or professional spheres, yet few focus specifically on specialty procedures such as radiosurgery or brachytherapy, despite several recommendations for such programs. In this manuscript we describe a specialized SRS/SBRT credentialing program founded on national/international standards and guidelines. We also present the results of an anonymous survey from institutions who have completed the program.

Factors influencing teamwork in healthcare applicable to interventional and diagnostic radiology

Teamwork in healthcare has been analysed extensively in the literature, mainly in acute healthcare settings such as the operating room, emergency room, and intensive care unit, with limited evidence related to diagnostic and interventional radiology. Multiple factors that affect teamwork in different domains have been described, such as communication, hierarchy, and distractions. Teamwork is an important patient safety, job satisfaction and patient outcome determinant, with interprofessional and interdisciplinary healthcare education playing a relevant role in the different domains affecting team performance. The aim of this article is to review the literature to describe domains and specific factors that influence teamwork in diagnostic and interventional radiology practice. This is of particular interest for radiologist involved in quality improvement and/or patient safety initiatives development and implementation. The review will conclude with a summary table highlighting the most important factors that, according to the authors, appear relevant to the radiology practice.

Enhancing Patient Safety Culture in Hospitals

Patient safety has become a top priority for healthcare organizations. A better patient safety environment is associated with a lower probability of significant complications. Training programmers is critical to promoting patient safety and minimizing misunderstandings. The quality, performance, and productivity of the healthcare industry can be dramatically improved by changing the patient safety atmosphere operating within the hospital sector. Hospitals can significantly reduce medical errors and adverse events by implementing the program and training programmers to prioritize patient safety. This will improve patient outcomes and increase efficiency and effectiveness. Creating a patient safety culture within hospitals will contribute to a higher standard of care and improved overall performance in the healthcare industry. Hospitals can identify systemic problems and implement proactive measures to prevent future incidents by creating an environment in which healthcare professionals feel comfortable reporting errors. A patient safety culture encourages collaboration and open communication among healthcare teams leading to more effective and coordinated care.

Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts

Patient harm is a leading cause of global disease burden with considerable morbidity, mortality, and economic impacts for individuals, families, and wider society. Large bodies of evidence exist for strategies to improve safety and reduce harm. However, it is not clear which patient safety issues are being addressed globally, and which factors are the most (or least) important contributors to patient safety improvements. We aimed to explore the perspectives of international patient safety experts to identify: (1) the nature and range of patient safety issues being addressed, and (2) aspects of patient safety governance and systems that are perceived to provide value (or not) in improving patient outcomes. English-speaking Fellows and Experts of the International Society for Quality in Healthcare participated in a web-based survey and in-depth semistructured interview, discussing their experience in implementing interventions to improve patient safety. Data collection focused on understanding the elements of patient safety governance that influence outcomes. Demographic survey data were analysed descriptively. Qualitative data were coded, analysed thematically (inductive approach), and mapped deductively to the System-Theoretic Accident Model and Processes framework. Findings are presented as themes and a patient safety governance model. The study was approved by the University of South Australia Human Research Ethics Committee. Twenty-seven experts (59% female) participated. Most hailed from Africa (n = 6, 22%), Australasia, and the Middle East (n = 5, 19% each). The majority were employed in hospital settings (n = 23, 85%), and reported blended experience across healthcare improvement (89%), accreditation (76%), organizational operations (64%), and policy (60%). The number and range of patient safety issues within our sample varied widely with 14 topics being addressed. Thematically, 532 textual segments were grouped into 90 codes (n = 44 barriers, n = 46 facilitators) and used to identify and arrange key patient safety governance actors and factors as a 'system' within the System-Theoretic Accident Model and Processes framework. Four themes for improved patient safety governance were identified: (1) 'safety culture' in healthcare organizations, (2) 'policies and procedures' to investigate, implement, and demonstrate impact from patient safety initiatives, (3) 'supporting staff' to upskill and share learnings, and (4) 'patient engagement, experiences, and expectations'. For sustainable patient safety governance, experts highlighted the importance of safety culture in healthcare organizations, national patient safety policies and regulatory standards, continuing education for staff, and meaningful patient engagement approaches. Our proposed 'patient safety governance model' provides policymakers and researchers with a framework to develop data-driven patient safety policy.

Identifying Factors that Support the Delivery of Exceptional Care in General Practice and Development of the IDEAL Framework: A Qualitative Study

The positive deviance approach seeks to identify and learn from those that perform exceptionally well. Positive deviance as an approach to quality improvement is gaining traction in general practice. This study aimed to explore and compare stakeholders' perceptions of the factors that support the delivery of exceptional care in general practice and to refine a previously developed theoretical framework of factors associated with positively deviant care in general practice: the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. Semi-structured interviews were conducted with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers in Irish general practice. Subsequently, a directed content analysis approach was employed to deductively analyse interview data using the IDEAL framework, and newly emerging factors were inductively analysed and abstracted into the framework. Several distinct strategies (e.g. patient activation and team collaboration), structures (e.g. facilities and staffing), and contextual factors (e.g. communication and rapport, and culture) were found to support the delivery of exceptional care, and differences in perceptions, values, and expectations emerged between patients and practice staff. Interview data largely supported the pre-determined factors posited by the IDEAL framework, and new factors were abstracted into the framework (e.g. facilities and infrastructure). Stakeholder engagement regarding the factors supporting exceptional care in general practice supported and extended the IDEAL framework, contributing to a more comprehensive understanding of how exceptional care is delivered in general practice. The refined framework will support researchers, policymakers, and teams looking to support, measure, and achieve exceptionally good patient care in general practice.

The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status

With the recent change to value-based care, institutions have struggled with the appropriate management of patients under observation. Observation status can have a huge impact on hospital and patient expenses. Institutions have implemented specialized observation units to provide better care for these patients. Starting in January 2020, coinciding with the initiation of daily multidisciplinary rounds, our study focused on patients aged 18 and older admitted to our hospital under observation status. Efforts were built upon prior initiatives at Jersey Shore University Medical Center (JSUMC) to optimize patient care and length of stay (LOS) reduction. The central intervention revolved around the establishment of daily "Observation Huddles"-succinct rounds led by hospital leaders to harmonize care for patients under observation. The primary aim was to assess the impact of daily multidisciplinary rounds (MDR) on LOS, while our secondary aim involved identifying specific barriers and interventions that contributed to the observed reduction. Our study revealed a 9-h reduction in observation time, resulting in approximately USD 187.50 saved per patient. When accounting for the period spanning 2020 to 2022, potential savings totaled USD 828,187.50 in 2020, USD 1,046,062.50 in 2021, and USD 1,243,562.50 in 2022. MDR for observation patients led to a reduction in LOS from 29 h to 20 h (p < 0.001).

Fair Healthcare Practices in Orthopedics Assessed with a New Framework

Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.

Patient safety culture in South America: a cross-sectional study

BACKGROUND

Every year, millions of patients suffer injuries or die due to unsafe and poor-quality healthcare. A culture of safety care is crucial to prevent risks, errors and harm that may result from medical assistance. Measurement of patient safety culture (PSC) identifies strengths and weaknesses, serving as a guide to improvement interventions; nevertheless, there is a lack of studies related to PSC in Latin America.

AIM

To assess the PSC in South American hospitals.

METHODS

A multicentre international cross-sectional study was performed between July and September 2021 by the Latin American Alliance of Health Institutions, composed of four hospitals from Argentina, Brazil, Chile and Colombia. The Hospital Survey on Patient Safety Culture (HSOPSC V.1.0) was used. Participation was voluntary. Subgroup analyses were performed to assess the difference between leadership positions and professional categories.

RESULTS

A total of 5695 records were analysed: a 30.1% response rate (range 25%-55%). The highest percentage of positive responses was observed in items related to patient safety as the top priority (89.2%). Contrarily, the lowest percentage was observed in items regarding their mistakes/failures being recorded (23.8%). The strongest dimensions (average score ≥75%) were organisational learning, teamwork within units and management support for patient safety (82%, 79% and 78%, respectively). The dimensions 'requiring improvement' (average score <50%) were staffing and non-punitive responses to error (41% and 37%, respectively). All mean scores were higher in health workers with a leadership position except for the hospital handoff/transitions item. Significant differences were found by professional categories, mainly between physicians, nurses, and other professionals.

CONCLUSION

Our findings lead to a better overview of PSC in Latin America, serving as a baseline and benchmarking to facilitate the recognition of weaknesses and to guide quality improvement strategies regionally and globally. Despite South American PSC not being well-exploited, local institutions revealed a strengthened culture of safety care.

Impact of Target Management Card on Patient Safety in the Emergency Department: A Mixed Methods Study

Purpose

This study aimed to investigate the potential impact of the Target Management Card on patient safety in the emergency department.

Patients and Methods

A mixed method design was developed, combining a one-group pretest-posttest design with a qualitative study. Target Management Cards were formulated for 32 emergency nurse practitioners and focus group interviews were conducted after the intervention. Wilcoxon's signed rank test was used to compare pre-test and post-test scores. The interview data were subject to content analysis.

Results

After developing the Target Management Card, there were significant improvements in safety behaviors (Z = 4.709, p < 0.01) and perception of patient safety (Z = 4.257, p < 0.01) among emergency nurse practitioners. The nurses in the focus group interviews agreed that the Target Management Card could improve patient safety by warning and supervising nursing work in the emergency department, promoting a positive change in nurses' attitudes and behaviors toward patient safety.

Conclusion

Our study found that nurses and nursing managers jointly formulating Target Management Cards in emergency departments significantly enhances patient safety.

Influence of work and family environment on burnout among emergency medical technicians

OBJECTIVE

Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability.

METHODS

A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory (MBI-HSS). Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire (BJSQ). Family-work negative spillover was measured using the Japanese version of Survey Work-Home Interaction-NijmeGen (SWING). The cutoff value for burnout syndrome was defined as emotional exhaustion≥27 and/or depersonalization≥10.

RESULTS

A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis. Low supervisor support (odds ratio, 1.421; 95% confidence interval, 1.136-1.406; P<0.001) and high family-work negative spillover (odds ratio, 1.264; 95% confidence interval, 1.285-1.571; P<0.001) were independent factors associated with higher probability of burnout.

CONCLUSION

This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.

Using an Educational Intervention to Map our Surgical Teams' Function, Emotional Intelligence, Communication and Conflict Styles

OBJECTIVE

The leadership team invited surgical team members to participate in educational sessions that created self and other awareness as well as gathered baseline information about these topics: communication, conflict management, emotional intelligence, and teamwork.

DESIGN

Each educational session included an inventory that was completed to help participants understand their own characteristics and the characteristics of their team members. The results from these inventories were aggregated, relationships were identified, and the intervention was evaluated.

SETTING

A level 1 trauma center, Baylor Scott and White Health, in central Texas; a 636-bed tertiary care main hospital and an affiliated children's hospital.

PARTICIPANTS

An open invitation for all surgical team members yielded 551 interprofessional OR team members including anesthesia, attending physicians, nursing, physician assistants, residents, and administration.

RESULTS

Surgeons' communication styles were individual focused, while other team members were group focused. The most common conflict management mode for surgical team members on average was avoiding, and the least common was collaborating. Surgeons primarily used competing mode for conflict management, with avoiding coming in a close second. Finally, the 5 dysfunctions of a team inventory revealed low accountability scores, meaning the participants struggled with holding team members accountable.

CONCLUSIONS

Helping team members understand their own and others' strengths and blind spots will help create opportunity for more purposeful and clear communication. Additionally, this knowledge should improve efficiency and safety in the high-stakes environment of the operating room.

Pharmacists' Perceptions of Physician-Pharmacist Collaboration-A 2022 Cross-Sectional Survey in Poland

Patient-centered care requires close collaboration among multiple healthcare professionals, including physician-pharmacist collaboration (especially as a part of pharmaceutical care). This study aimed to assess pharmacists' perceptions of physician-pharmacist collaboration as well as to identify factors associated with the willingness to provide pharmaceutical care services in Poland. This questionnaire-based survey was carried out in 2022 among community pharmacists from one of the largest franchise chain pharmacy networks in Poland. Completed questionnaires were received from 635 community pharmacists (response rate of 47.9%). Almost all the pharmacists agreed with the statement that there is a need for physician-pharmacist collaboration (98.2%), and 94.8% declared that pharmacists can help physicians in patient care and pharmacotherapy. Most pharmacists (80%) believed that physicians were not aware of the competencies of pharmacists resulting from Polish law. Patient education (89.9%), detection of polypharmacy (88%), and detection of interactions between drugs and dietary supplements (85.7%) were the most common tasks in the field of pharmaceutical care that can be provided by a pharmacist. Females were more likely (p < 0.05) to declare the need for physician-pharmacist collaboration. Age and location of the pharmacy were the most important factors (p < 0.05) associated with pharmacists' attitudes toward physician-pharmacist collaboration.

Senior nursing student's confidence in learnt competencies and perceptions of patient safety competency: a multisite cross-sectional study

OBJECTIVE

Nursing students' attainment of patient safety (PS) competency has always been a global concern among health and educational organisations. Therefore, this study was conducted to determine senior nursing students' confidence of their PS competencies, and associated predictive factors.

DESIGN

Cross-sectional study.

SETTING

Four faculties from the nursing faculties of East Azerbaijan province.

PARTICIPANTS

253 senior nursing students in Iran.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using the modified version of the Health Professional Education Patient Safety Survey, data related to the level of confidence of nursing students in acquired competencies in seven sociocultural dimensions of PS in classroom learning and clinical settings were collected. In addition, the predictors of the patient's safety competencies were identified by linear regression statistics.

RESULTS

Mean scores of all dimensions of PS competencies both in the classroom and in clinical settings were higher than 3.11 (out of 5). The nursing students were most confident in their learning of 'understanding human and environmental factors' in the classroom and the clinical setting. Nursing students displayed the least confidence in learning 'work in teams with other health professionals' in both the classroom and the clinical settings. Type of university, prior experience with PS competencies education, and coverage of PS competency issues in the curriculum predicted the students' perceived competency scores in the classroom (R2=0.53, p<0.001). Also, perceived competence in the clinical settings was predicted by the variables of reporting errors to personnel and peers and the type of university (R2=0.65, p<0.001).

CONCLUSION

Study findings emphasise the role of learning environments and educational experiences of nursing students especially the clinical environment, clinical instructors and the hidden curriculum in improving safety competence. Nursing educators can use this information to revise and develop the undergraduate nursing curriculum, paying close attention to lesson plans and content in relation to teaching safety issues.

Guidelines on human factors in critical situations 2023

OBJECTIVE

To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care.

DESIGN

A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based.

METHODS

We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology.

RESULTS

The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions.

CONCLUSION

Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.

Patient safety culture and associated factors among health care providers in government and private hospitals, Bahir Dar City Northwest, Ethiopia, 2022: a comparative cross-sectional study

BACKGROUND

Patient safety in a healthcare setting is now a major global concern. Millions of people suffer disabling injuries or death directly related to medical care errors, particularly in developing countries. Evidence about patient safety culture in Ethiopia is limited. Therefore, this study was designed to assess the level of patient safety culture and associated factors among healthcare providers in government and private healthcare providers.

METHODS AND MATERIALS

Institution based cross-sectional study was conducted from May to June 30, 2022. Self-administered hospital survey on Patient Safety Culture (HSOPSC) tool was used to select 448 study participants. Epi Data version 4.6 and SPSS version 26 were used for data entry and analysis. Chi-square test, Bi-variable, and multivariable logistic regressions were done to determine the association between the independent and outcome variable.

RESULT

A total of 448 healthcare providers with a response rate of 99.6% participated. The prevalence of good patient safety culture was 50.9%( 95%CI: 46.2, 55.6%). Patient safety culture difference was observed between government and private healthcare providers (× 2 = 22.6, df = 1, p = 0.000). Type of hospitals (AOR = 0.37(95% CI:(0.21, 0.68), profession (AOR = 2.16 (95% CI:(1.02,4.62), job satisfaction (AOR = 0.19,95%CI:(0.12,0.30), participated in patient safety programs(AOR = 2.69:(95%CI:1.53,4.75), providing necessary equipment and materials (AOR = 2.05(95%CI: 1.18,3.55%), and work shift (AOR = 0.47( 95%CI: 0.25,0.93) were found significantly associated with good patient safety culture among healthcare providers.

CONCLUSION

The prevalence of good patient safety culture was relatively low. Patient safety culture difference is observed between government and private healthcare providers. Type of hospitals (public or private), profession, job satisfaction, participation in patient safety programs, providing necessary equipment and materials, and work shifts were associated factors for patient safety culture. Therefore, it is better to design patient safety improvement strategies for both government and private healthcare providers.

Sound psychometric properties of a short new screening tool for patient safety climate: applying a Rasch model analysis

BACKGROUND

WHO recommends repeated measurement of patient safety climate in health care and to support monitoring an 11 item questionnaire on sustainable safety engagement (HSE) has been developed by the Swedish Association of Local Authorities and Regions. This study aimed to validate the psychometric properties of the HSE.

METHODS

Survey responses (n = 761) from a specialist care provider organization in Sweden was used to evaluate psychometric properties of the HSE 11-item questionnaire. A Rasch model analysis was applied in a stepwise process to evaluate evidence of validity and precision/reliability in relation to rating scale functioning, internal structure, response processes, and precision in estimates.

RESULTS

Rating scales met the criteria for monotonical advancement and fit. Local independence was demonstrated for all HSE items. The first latent variable explained 52.2% of the variance. The first ten items demonstrated good fit to the Rasch model and were included in the further analysis and calculation of an index measure based on the raw scores. Less than 5% of the respondents demonstrated low person goodness-of-fit. Person separation index > 2. The flooring effect was negligible and the ceiling effect 5.7%. No differential item functioning was shown regarding gender, time of employment, role within organization or employee net promotor scores. The correlation coefficient between the HSE mean value index and the Rasch-generated unidimensional measures of the HSE 10-item scale was r = .95 (p < .01).

CONCLUSIONS

This study shows that an eleven-item questionnaire can be used to measure a common dimension of staff perceptions on patient safety. The responses can be used to calculate an index that enables benchmarking and identification of at least three different levels of patient safety climate. This study explores a single point in time, but further studies may support the use of the instrument to follow development of the patient safety climate over time by repeated measurement.

Issues and complexities in safety culture assessment in healthcare

The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.

Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success

BACKGROUND

Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events.

CONCEPTUAL FRAMEWORK

The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ.

IMPLICATIONS

Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.

APSIC guide for prevention of catheter associated urinary tract infections (CAUTIs)

BACKGROUND

The Asia Pacific Society of Infection Control launched the APSIC guide for prevention of catheter associated urinary tract infections in July 2022. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities in the Asia Pacific region to achieve high standards in infection prevention and control practices during the management and care of patients with a urinary catheter.

METHODS

The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.

RESULTS

It recommends that healthcare institutions have a catheter associated urinary tract infection prevention program that includes surveillance and the use of the insertion and maintenance bundles. Implementation of the bundles is best done using a quality improvement approach with a multidisciplinary team.

CONCLUSIONS

Healthcare facilities should aim for excellence in care of patients with urinary catheters. It is recommended that healthcare facilities have a catheter associated urinary tract infection prevention program as part of their Infection Prevention and Control program.

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before-after study in operating theatres in the Netherlands

OBJECTIVES

To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT).

DESIGN

Multicentre before-after study.

SETTING

This study was performed in four Dutch hospitals.

INTERVENTION

The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. Poisson and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures).

RESULTS

Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration.

CONCLUSION

This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.

Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care.

OBJECTIVE

This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions.

METHODS

This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality.

RESULTS

This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024.

CONCLUSIONS

The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/46187.